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HOLIDAY

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There comes a time in every pregnancy when all that's left to do is...wait. The books have been read, the nursery decorated, the car seat installed. "Once you get to 37 weeks of pregnancy, your baby could be born at any time," says Susan Cooter, RN, director of Prepared Childbirth Educators, an organization based in Hatboro, Pennsylvania.

But even though most women give birth between 37 and 42 weeks — a fairly broad span — there's no way to pinpoint when labor will begin. "Not knowing makes some women very anxious," says Cooter, who is also a certified doula, an individual who is trained to provide emotional and physical support to women in labor.

If you're a first-time mom, you may not even realize when you're officially in labor. "Plenty of women head to the hospital only to be told to go back home," notes Cooter. It can be hard to distinguish Braxton Hicks contractions, also known as false contractions, from the real thing. But if your contractions gradually become stronger, last longer, and are getting closer together, chances are that labor has begun.

Even if you're in true labor, it may take a while before you're sure, so in the early stages of labor, you're better off at home where you'll be more comfortable. After all, a first-time mom can expect to be in labor for 12 to 14 hours, according to the American College of Obstetricians and Gynecologists. "Labor with subsequent pregnancies usually goes faster," Cooter says.

When it does come time to check in to the hospital or birthing center, keep in mind that things don't always (or more accurately, don't usually) go exactly as planned. You may not be able to get the epidural you wanted, or you may end up needing a cesarean. "It's fine to have an idea of how you'd like the birth to go, but you need to be flexible," says Cooter.

Keeping in mind that labor is different for every woman, and for each of her pregnancies, here's what you might expect.

First Stage of Labor: Dilation and Effacement of the Cervix

Your physician will likely have told you when to call her or go to the hospital, but it's typically when contractions happen at regular intervals, such as every 8 or 10 minutes, and get closer together. Other indications that you're in labor include the "rupture of membranes" (when your water breaks), losing the mucus plug, and passing bloody discharge, called "show."

Remember that not all women experience all of these signs of labor, so if you're unsure, call your caregiver.

Early (or Latent) Phase: Cervix dilates from zero to three or four centimeters

The early phase of labor is sometimes (lightheartedly) called "the entertainment phase," because it's often helpful to focus your mind on other things so that you can pass the time without worrying about what's coming. As long as contractions are still relatively mild and spaced farther than five or so minutes apart, most women spend the time at home, and maintain close contact with their practitioner.

In general, contractions can be mild and somewhat irregular, coming from 5 to 30 minutes apart, lasting 30 to 45 seconds. You might see some pinkish discharge and feel a bit of abdominal discomfort. The "water" may "break" (rupture of membranes) in this early phase, or this may happen later in the first or second stage, either on its own or with help from your practitioner.

How long it lasts: This first step in the journey toward childbirth lasts an average of 6 to 10 hours for a first-time mother, but can be much shorter (2 to 5 hours) if you've given birth before.

Signs: During this phase, contractions usually last between 30 and 60 seconds; they generally start 20 minutes apart and move to about 5 minutes apart. Look for contractions that continue even if you move around, that get stronger, and that start in your back and move around to the front.

What you can do to make it more comfortable: Anything that helps you relax, says Cooter. "Rest, shower, eat a small meal, take a walk, and practice slow-paced breathing," she says.

Active Phase: Cervix dilates from four to seven centimeters

This phase is when the serious prep work for childbirth begins, and when most women begin to labor more intensely. During the active phase, contractions usually come steadily, gradually increasing in intensity and frequency, from three to five minutes apart.

Pains may be centered in the lower back, abdomen, or thighs, and they may be intense enough to make it hard for you to talk. You might also experience an increased amount of pinkish or brownish discharge, or what's sometimes called a "bloody show."

How long it lasts: 3 to 6 hours for a first-time mom; 1 to 3 hours for subsequent labors. If you've taken Pitocin, a drug that induces contractions, this phase may go more quickly, but if you've had an epidural, things can slow down.

Signs: Contractions are increasingly more intense, last for 45 to 60 seconds, and are 3 to 5 minutes apart. Some women feel discomfort in their back and hips and cramping in their feet and legs; this is the point when many women ask for an epidural. However, even with pain relief, active labor can unhinge some women's tempers. "I think this was about when I started to yell at my husband," says Kearney. "It hurt, and I had to take it out on someone."

What you can do to make it more comfortable: By this point in labor, you have been admitted to the hospital or ensconced at your birthing center. If you have your epidural in place, you may not be able to get out of bed, but it's still a good idea to change position every half hour or so. If you can get out of bed, try walking up and down stairs for a few minutes at a time (if hospital policy allows it) or marching in place.

"This movement encourages the cervix to open and helps the baby rotate into the birth position," says Cooter. This is also a good time to use the relaxation techniques you learned in childbirth education class and to enlist your partner for emotional support. Your hospital may also want to monitor the baby's heartbeat with a stethoscope, a handheld Doppler device, or an electronic monitoring device.

Transition phase: Cervix dilates to eight to ten centimeters

Contractions during this phase are usually intense, spaced about one to three minutes apart. Increasing fatigue, shakiness, and nausea are all common in this phase, as your body does the hard work of reaching complete dilation and effacement.

You may feel a strong urge to push or bear down, along with pressure in the rectal area and stinging in the vaginal area as the baby's head moves down toward the vaginal opening. But you should NOT push — wait until your practitioner gives you the go-ahead, which will happen when the cervix is fully dilated.

How long it lasts: This is the shortest but most intense phase, typically lasting from 10 minutes to 2 hours.

Signs: Contractions are increasingly intense and last between 60 to 90 seconds, and they're 1 1/2 to 2 minutes apart. You may feel pelvic and rectal pressure, have hot flashes and/or chills, have cold feet, and feel nauseous or even vomit. You may feel overwhelmed, and it's also normal to feel discouraged, as though labor will never end.

What you can do to make it more comfortable: Imagine you're in a place that makes you feel safe and relaxed — lying on the beach, resting against a tree, or sitting in a rocking chair in your baby's nursery. Breathe deeply and develop the scene, filling in the details. What do you see? What do you smell? What do you hear? If you're in more pain than you expected, it's usually not too late to ask for pain relief at this point. However, whether you get any will depend on whether an anesthesiologist is available.

Second Stage of Labor: Pushing and Birth

The second stage of childbirth begins when the cervix is fully dilated. Your baby is moving down the birth canal. Contractions continue to be strong, lasting for about 60 seconds and coming 3 to 5 minutes apart. You will likely feel a strong urge to push.

The overwhelming urge to bear down continues, and as soon as your cervix is fully dilated, your practitioner will probably give you the go ahead to push. Contractions don't stop now, though they often come farther apart. Some women experience nausea and vomiting. As you begin pushing, you may become increasingly breathless and fatigued — you are getting what is likely the hardest workout of your life.

How long it lasts: 1 to 2 hours for a first labor; 15 to 30 minutes for subsequent labors. If your baby is in distress at this point, or if she doesn't seem to be making her way through the birth canal, your doctor may decide to deliver her by c-section or use forceps to help her out.

Signs: You may feel intense pain around your vaginal and perineal areas as the baby's head crowns, or protrudes at its widest part outside the vaginal opening. If you have an episiotomy (an incision made in the area between the vagina and the rectum to widen the vaginal opening) it will probably happen at this point. You may be asked to push more gently or slowly as the rest of your baby's head and body emerge. Finally, with one last push, your baby is out in the world!

What you can do to make it more comfortable: Take solace in knowing that you're almost there! Concentrate on pushing your baby down and out. Your partner can help by encouraging you to push and to rest in between pushes. Don't be afraid to try different positions — for instance, get on your hands and knees or kneel while your partner supports your upper body.

Third Stage of Labor: Delivery of Placenta

The incredible moment of baby's birth is followed swiftly by the delivery of the placenta (sometimes called "the afterbirth"). You'll likely be so absorbed in getting to know your newborn that you won't notice much about this stage!

How long it lasts: 1 to 20 minutes for first and subsequent pregnancies.

Signs: Minutes after your baby is born, you feel contractions again. This usually causes the placenta to separate from the uterine wall. When your doctor sees signs of separation, she will ask you to push again to expel the placenta. In some cases, she may need to reach inside and help pull out the placenta.

What you can do to make it more comfortable: Be patient. As Davis notes, "I had a new baby, so it was pretty easy to deal with this last, relatively quick bit of discomfort."

Common Questions About Labor

When should I go to the hospital?

When to go to the hospital will depend on how your labor is progressing. In general, you should go when the contractions have become strong enough to take your breath away and are coming regularly, at five- to 10-minute intervals, says Patricia Burch, M.D., an obstetrician and gynecologist in Lafayette, Louisiana. At this point, the cervix is usually 3–4 centimeters dilated and completely effaced.

Some childbirth experts believe it is unwise to go into the hospital too soon. “Many studies have shown that a woman is better off, and requires less medical intervention, when she stays home and remains in contact with her doctor or midwife by telephone until she’s further along in labor,” says Marsden Wagner, M.D., a Washington, D.C., reproductive-health research scientist who spent 15 years as director of women’s and children’s health for the World Health Organization.

If you choose not to go to the hospital right away, call your health practitioner to inform her that you think labor has begun. Rest and keep your strength up by eating a snack, because it’s likely to be a long time before you can eat again, says Giselle Genillard, a licensed midwife in Santa Fe, N.M. She suggests light, nutritious foods such as yogurt and toast.

Although physicians used to ask women to report to the hospital as soon as their water broke, opinions on the subject currently run the gamut. “Some doctors will have women wait 12 hours to see if labor starts, while others will give you 24,” says Burch. “Others, like myself, prefer to check the woman out in the office and put her on a fetal monitor for 20 minutes to make sure everything is OK. Find out your health care practitioner’s policy on this before you go into labor.”

What's the best position for delivery?

Doctors vary on what they will allow for delivery, so inquire before labor begins. The most common position is propped up on one’s back, with knees open wide and high. Squatting is considered one of the best positions for labor because it helps open up the pelvis. You can squat with support from a partner or hang onto a birthing bar, which is hooked onto a birthing bed. This type of bed allows you to squat in bed and then lean back in between contractions. Birthing beds also break down and become what looks like a delivery table so the woman can push and deliver the baby without being moved.

Birthing chairs are often used by midwives. They are helpful for a woman having trouble getting the baby down the birth canal. Sitting in a birthing chair helps open up the pelvis wider than in a birthing bed. Delivering while lying on one’s side works well, opening the pelvis, as does all-fours delivery, which works particularly well for women experiencing back labor.

What does labor and delivery feel like?

Labor feels like extremely strong menstrual cramps that take your breath away and make you unable to talk. As labor continues and the pain worsens, the woman tunes out stimuli and adopts a tunnel vision, focusing on the labor and getting the baby out. Eventually the woman’s cervix dilates completely; at this point, she is ready to push and give birth.

During this phase, some women feel clingy, not wanting their husbands or birth partners to leave their sides; some yell and become uncharacteristically demanding; some tremble and feel overwhelmed and anxious; and some lose all sense of modesty. To some people, pushing feels like you are having a large bowel movement. When the baby finally starts to come out, many women think they’ve pooped.

What if I have a Caesarean section?

Twenty-five percent of women in the United States have a C-section, so you wouldn’t be alone. Although the recovery time is longer and more painful, women who deliver this way are just as able to hold their babies after delivery and breastfeed soon after. During a Cesarean, the woman is typically awake and able to watch the baby being removed from her uterus. She also can be accompanied by her husband or other loved one. Having a C-section does not mean that you can’t deliver vaginally the next time around.